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Sponsoring J-1 Exchange Visitors
IMPORTANT! Please read the following carefully regarding the J-1 research scholar and
professor categories. Contact us if you have any questions.

J-1 scholars and professors are limited to a maximum five-year stay. NO EXTENSIONS
BEYOND THE FIVE YEARS WILL BE GRANTED. This does NOT APPLY to any other J-1
exchange visitor category including short term research scholars, students, specialists etc… For
shorter programs (six months or less), it may be prudent to consider the short term research
scholar category.

The five years will now be counted from the start date of the J-1 program, listed on scholar/
professor’s DS-2019. This is NOT five years from his/her entry date into the US.
be sure to request a program start date close to the time of the scholar’s arrival so program time
is not lost due to travel or visa processing. You can check visa processing waits and timetables
for the appropriate consulate at this Department of State website
http://travel.state.gov/visa/temp/wait/wait_4638.html

The 12 and 24 month bars for Professors and Research Scholars (not the 212e two year
home residency requirement)
   • 12 month bar after previous J-1 participation- Unless the exchange visitor is transferring
      from one program to another, time spent in the United States of six months or more in
      any J status (including J-2 status but excluding J-1 short-term research scholar) during
      the 12-month period preceding the prospective professor or research scholar's program
      begin date will prohibit an alien's eligibility for participation as a Professor or Research
      Scholar.

   •   24 month bar on repeat participation- Unless the exchange visitor is transferring from
       one program to another, any J-1 scholar/ professor (regardless of entry date) who is in
       the US (for any period of time) with an active DS-2019 will be bared from “repeat
       participation in J-1 scholar/ professor categories” for a total of two years once the
       program is “completed” in SEVIS. The scholar/ Professor MAY change his/her
       immigration status or reenter in another J-1 category before the end of the two years
       (depending on the scholar/ professor’s subjectivity to 212e and/or the above 12 month
       bar).

NOTE: Though the 12 month bar, 24 month bar and 212e two year home residency
requirement are separate requirements, they can be completed simultaneously (within
the same two years).

It is the scholar’s responsibility to ensure that he/she does not violate these bars. Therefore, we
have made a page for the prospective scholar/ professor to complete with personal information
and sign regarding any previous J-1 of J-2 experiences.

Furthermore, it is MANDATORY that we know a scholar/ professor’s actual end day for his/ her
VCU program and any plans for the near future regarding potential transfers to new programs. If
the scholar/ professor has no plans, we will have to end their program when the VCU
department tells us it is complete, thus activating the 24 month bar. However, IF the scholar
plans to transfer to another J-1 scholar/ professor program within the next two months, AND IF
we get ADEQUATE information from the new program, we can maintain that SEVIS record in
“active” status until the transfer date. The information we receive will have direct
consequences on the scholar’s future opportunities in the US.
We will issue the DS-2019 only when we have the following documentation with all required
attachments:
       1) NEW: J-1 DS-2019 processing fee $30 due to GEO-IS at time of DS-2019
           application. This fee may be transferred via Journal Voucher to index number 1-
           10209 (account 600099). Please write the journal voucher number on
           application form.

        2) A letter from the department inviting the scholars and outlining their program
           objectives for VCU.

        3) A statement of financial support from his or her sponsor that must include the
           proposed dates of the visit, the funding source and confirmation that he or she will be
           compensated a minimum of $1500 per month. The compensation amount must be
           appropriately documented in the form of a bank statement, a letter from the sponsor
           or a letter from a bank official. An adequate amount of funding must be received
           during the entire proposed length of stay at VCU.

        4) If the request is for a scholar or student coming from outside the U.S., a legible
           copy of the passport pages identifying legal name and date of birth must
           accompany this request. If the request is for a scholar or student transferring from
           another institution within the U.S., copies of all prior DS-2019 forms must accompany
           this request. VCU will issue a DS-2019 on the day of arrival if the current institution
           approves the transfer. Note: Please read category descriptions on the GEO-IS
           Web site before determining which category to use for your visitor, as some
           categories have legal restrictions.

        5) A copy of the terminating degree certificate with a certified translation.

        6) Complete the last page of the attached form if spouse or children under 18 will
           accompany the visitor. Additional financial support for the dependents must be
           included in the statement in item 2 above. A minimum of $5000 per year must be
           provided for each dependent.

        7) If the sponsoring department would like to advance the scholar up to $1,000 for
           immediate financial support, there are instructions for the Foreign Visitor’s Loan
           Program on the VCU Web site at http://www.vcu.edu/treasury/FVLP.htm.

IMPORTANT:
Federal regulations governing the Exchange Visitor Program require that all exchange visitors
and dependents have health/accident insurance that includes repatriation costs for remains and
medical evacuation coverage during their stay in the US. Under the regulations, the university is
not required to pay for the insurance coverage, but must ensure that the visitor and all
accompanying dependents have coverage that is valid in the U.S.

Also, J-1 exchange visitors are not eligible for a social security number if they will not be
receiving any US funds. Please keep this in mind when sponsoring a visitor who will not be
receiving US funds.
(Please attach documentation to confirm that the visitor was informed of this federal regulation
and that he or she should present proof of coverage upon his or her arrival at VCU.)




Updated 2010
Global Education Office - Immigration Services
817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284   Tel: (804) 828-0595   Fax: (804) 828-2552
J-1 Scholar Request
Please provide the information requested below for the issuance of a DS-2019 form. This form, along with
any required attachments, should be submitted to: Global Education Office- Immigration Services, Box
843043, 817 W. Franklin St., Richmond, VA 23284-3043. Please submit the request at least three
months prior to the visitor’s expected arrival date to allow time for consular interview.

Department Information:

Name of faculty sponsor _______________________________________ Campus phone ____________

Alternate contact __________________________________________________ Phone _____________

Department/School __________________________________Campus Box number __________

A photocopy of the letter of invitation to the visitor is attached    Yes_____

NEW: $30 Journal Voucher number __________________________

The purpose of this form is to:           Visitor’s name: _______________________________________
   Begin a new J-1 program                                   Family/ surname                   First/ given

    Transfer a J-1 from another program to VCU.
If so, the original program begin date on the previous DS-2019 is ___________________________
                                                                               Month     Day      Year

Activity Information
Circle requested category of visitor:
(1) Professor (2) Research scholar          (3) Short-term scholar    (4) Specialist

(Note: research scholars and professors can stay up to five years from the begin date on their original
DS-2019. Once their program ends they will be subject to the new 24 month bar (not to be confused with
the 212e home residency requirement). If the program is going to be 6 months or less, short-term scholar
is another option which avoids the 24 month bar.)

Proposed length of stay at Virginia Commonwealth University:
From: _________________________         To: ____________________________
               Month      Day      Year                      Month      Day       Year
(Note: please see approximate visa application wait times at
http://travel.state.gov/visa/temp/wait/tempvisitors_wait.php)

Describe the specific field of study, research, training or professional activity in which the visitor will be

engaged (i.e., Visiting professor conducting research in head trauma). ___________________________

____________________________________________________________________________________

____________________________________________________________________________________

Is the visitor coming to fill a VCU postdoctoral position?      YES               NO

Street address where exchange visitor will perform duties__________________________________

___________________________________________________________________________________




Updated 2010
Global Education Office - Immigration Services
817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284     Tel: (804) 828-0595      Fax: (804) 828-2552
Funding Information                                           Scholar name __________________________
Indicate below the source(s) of funding* and an estimate of the amount of money (rounded to the nearest
dollar) the visitor will receive during the length of the program as will be indicated on the DS-2019 (include
in the estimate any perks such as room, board, tuition, etc.):

   1. Virginia Commonwealth University (includes positions funded by grants)           $__________________
   2. U.S. government agency(ies) _________________________________                    $__________________
   3. International organization(s) __________________________________                 $__________________
   4. The exchange visitor’s government                                                $__________________
   5. The Binational Commission of the visitor’s country                               $__________________
   6. All other organizations providing support                                        $__________________
   7. Personal funds                                                                   $__________________

*Please attach supporting documents that confirm all sources of funding for the visitor’s
proposed length of stay.

Health Insurance
Federal regulations governing the Exchange Visitor Program require that all exchange visitors and their
dependents must have health/accident insurance that includes repatriation and medical evacuation
coverage during their stay in the United States (not covered by VCU insurance). Under the regulations,
the university is not required to pay for the insurance coverage, but must ensure that the visitor and all
accompanying dependents have coverage that is valid in the United States.

Please indicate who will be responsible for the health insurance payments including medical evacuation &
repatriation:
_______________sponsoring department              ________________exchange visitor

Patient Contact Information
Is the visitor a physician or dentist?     No      Yes
If no, you can stop here. No additional letters are needed.
If yes, will the visitor have any patient contact?   No       Yes
     • If no, please complete letter A (see attached sample)
     • If yes, please note that visitors who are physicians are only permitted to have incidental patient
         contact as part of their primary educational or research objectives under an Exchange Visitor
         Program. Please complete letter B (see attached sample) if patient care is expected.

The below signers accept responsibility for assuring the payment of any funds obligated by VCU
as well as assuring that U.S. government regulations are met on behalf of the visitor(s). They must
ensure that upon arrival to the U.S., the visitor meets with a representative of GEO-IS. They also
must report to GEO-IS the termination or departure of the exchange visitor from the university.

_____________________________________              _________________________________________
Print name of faculty sponsor                     Print name of dean/department chair

_____________________________________             _________________________________________
Signature of faculty sponsor                      Signature of dean/department chair
(Original signatures in blue ink required.)

To ensure delivery of the DS-2019 this office will mail the documents to the exchange visitor by Federal
Express. If you do not have a Federal Express account, please contact us to make other arrangements.

______________________________ (Federal Express account number)



Updated 2010
Global Education Office - Immigration Services
817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284   Tel: (804) 828-0595      Fax: (804) 828-2552
Visitor Information (please print legibly)

   Male          Female                                                        Date of birth:__________________
   Dr.          Mr.    Mrs.           Ms.                                                           Month    Day    Year

____________________________________________________________________________________
Family/ Surname (As on Passport)                 Given name (As on Passport)                         Middle name

____________________________________________________________________________________
City of birth                                            Country of birth

____________________________________________________________________________________
Country of citizenship                           Country of legal permanent residence

Visitor’s level of education _______________________________                          Copy of degree attached _____

Visitor’s occupation and place of employment in their country: __________________________________

____________________________________________________________________________________

Email address: _____________________________________
Address and telephone number where DS-2019 should be mailed:______________________________

____________________________________________________________________________________

____________________________________________________________________________________
_
(NOTE: If the visitor’s family is accompanying the visitor, please type the following information
for each family member on the additional page: family name, first name; middle name; birth date;
relationship to scholar; city and country of birth, country of citizenship. A minimum of $5000 per
year must be provided for each dependent.)

       Are or have you (and/or any of your dependents) been in any J exchange visitor status (including J-
       2) within the past two years?       YES or        NO         If no, skip to the end.

       If you ARE in an active J-1 research scholar/ professor program NOW, what is the program begin
       date on your DS-2019? ____________________
                                     month      day    year
       If you (and/or any of your dependents)WERE in an active J exchange visitor status within the past
       two years, what status?       J-1 or     J-2 If J-1, what category? ______________________
       Attach extra sheet with dependent information                        (college student, short-term research scholar etc…)
       Please list the exact beginning and ending dates of your previous periods of J exchange visitor
       status.
       Start date __________________              End date __________________
                      month   day     year                         month       day        year
       If this application is for a transfer from another institution, have you applied for a waiver of
       Section 212e?         Yes         No

I pledge that the information above is correct and true. I am aware of the new
regulations governing J-1 research scholars and professors and agree to those
stipulations.
____________________________________________________________________________________
Visitor’s Family name                            Given name                                      month      day    year

____________________________________________________________________________________
Visitor’s Signature

Updated 2010
Global Education Office - Immigration Services
817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284          Tel: (804) 828-0595         Fax: (804) 828-2552
Will family members be accompanying exchange visitor?           yes        no
If yes, complete this sheet with the full name, relationship, date and place of birth and country of citizenship for each dependent.

Date: _________________

Exchange visitor: __________________________________________________________________
                              Family name                 First name            Middle name




Family Members Accompanying Visitor:

                                                                                                                                       Country of legal
                                                                                                  City & Country    Country of         permanent
   Family Name       First Name             Middle Name          Relationship     Date of Birth   of Birth          citizenship        residence


1. _______________________________________________________________________________________________________________________________


2. _______________________________________________________________________________________________________________________________


3. _______________________________________________________________________________________________________________________________


4. _______________________________________________________________________________________________________________________________


5. _______________________________________________________________________________________________________________________________



Eligibility Requirements For J-2 Dependents:

Please be advised that dependents are only the spouse and unmarried minor children (under 21 years of age) of the J-1 exchange visitor. Other family
members are not eligible for J-2 status.
Sample Letter A


The following must be printed on departmental letterhead and be signed by faculty
sponsor/department chair. The dean of the respective school also should countersign. Please
forward the original letter with signatures to Box 843043 or deliver to Room 221 817 W.
Franklin St. Please do not hesitate to call if you have any questions.

____________________________________________________________________________


Date



To Whom It May Concern:

This certifies that the program in which (name of physician/dentist) is to be engaged is solely for
the purpose of observation, consultation, teaching or research and that no element of patient
care is involved.



                              Approved: ___________________________
                                           Professor and Chair
                                           Department of______________


                              Approved: ___________________________
                                           Dean
                                           School of __________________
Sample Letter B


The following must be printed on departmental letterhead and be signed by faculty
sponsor/department chair. The dean of the respective school also should countersign. Please
forward the original letter with signatures to Box 843043 or deliver to Room 221 817 W.
Franklin St. Please do not hesitate to call if you have any questions.

____________________________________________________________________________


Date



To Whom It May Concern:

This is to certify that:

    A. The program in which ______________________________M.D./D.D.S will participate
       predominantly involves observation, consultation, teaching or research.

    B. Any incidental patient contact involving the alien physician/dentist will be under direct
       supervision of a physician/dentist who is a U.S. citizen or resident alien and who is
       licensed to practice medicine in the commonwealth of Virginia.

    C. The alien physician/dentist will not be given the final responsibility for the diagnosis and
       treatment of patients.

    D. Any activities of the alien physician/dentist will conform fully with the state licensing
       requirements and regulations for medical and health care professions in the state in
       which the alien physician/dentist is pursuing the program.

    E. Any experience gained in this program will not be creditable toward any clinical
       requirements for medical/dental specialty board certification.




                               Approved: ___________________________
                                         Professor and Chair
                                         Department of ______________


                               Approved: ___________________________
                                         Dean
                                         School of __________________

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Severe economic hardshipSevere economic hardship
Severe economic hardship
 
Transfer out clearance
Transfer out clearanceTransfer out clearance
Transfer out clearance
 
Transfer in clearance
Transfer in clearanceTransfer in clearance
Transfer in clearance
 
Optional practical training extension
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Optional practical training extension
 
Optional practical training follow-up
Optional practical training follow-upOptional practical training follow-up
Optional practical training follow-up
 
Curricular practical training
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Curricular practical training
 
Adding f-2 dependents
Adding f-2 dependentsAdding f-2 dependents
Adding f-2 dependents
 
Change of level
Change of levelChange of level
Change of level
 
Change of status to F-1
Change of status to F-1Change of status to F-1
Change of status to F-1
 
Extension request form
Extension request formExtension request form
Extension request form
 

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J-1 visitor sponsorship

  • 1. Sponsoring J-1 Exchange Visitors IMPORTANT! Please read the following carefully regarding the J-1 research scholar and professor categories. Contact us if you have any questions. J-1 scholars and professors are limited to a maximum five-year stay. NO EXTENSIONS BEYOND THE FIVE YEARS WILL BE GRANTED. This does NOT APPLY to any other J-1 exchange visitor category including short term research scholars, students, specialists etc… For shorter programs (six months or less), it may be prudent to consider the short term research scholar category. The five years will now be counted from the start date of the J-1 program, listed on scholar/ professor’s DS-2019. This is NOT five years from his/her entry date into the US. be sure to request a program start date close to the time of the scholar’s arrival so program time is not lost due to travel or visa processing. You can check visa processing waits and timetables for the appropriate consulate at this Department of State website http://travel.state.gov/visa/temp/wait/wait_4638.html The 12 and 24 month bars for Professors and Research Scholars (not the 212e two year home residency requirement) • 12 month bar after previous J-1 participation- Unless the exchange visitor is transferring from one program to another, time spent in the United States of six months or more in any J status (including J-2 status but excluding J-1 short-term research scholar) during the 12-month period preceding the prospective professor or research scholar's program begin date will prohibit an alien's eligibility for participation as a Professor or Research Scholar. • 24 month bar on repeat participation- Unless the exchange visitor is transferring from one program to another, any J-1 scholar/ professor (regardless of entry date) who is in the US (for any period of time) with an active DS-2019 will be bared from “repeat participation in J-1 scholar/ professor categories” for a total of two years once the program is “completed” in SEVIS. The scholar/ Professor MAY change his/her immigration status or reenter in another J-1 category before the end of the two years (depending on the scholar/ professor’s subjectivity to 212e and/or the above 12 month bar). NOTE: Though the 12 month bar, 24 month bar and 212e two year home residency requirement are separate requirements, they can be completed simultaneously (within the same two years). It is the scholar’s responsibility to ensure that he/she does not violate these bars. Therefore, we have made a page for the prospective scholar/ professor to complete with personal information and sign regarding any previous J-1 of J-2 experiences. Furthermore, it is MANDATORY that we know a scholar/ professor’s actual end day for his/ her VCU program and any plans for the near future regarding potential transfers to new programs. If the scholar/ professor has no plans, we will have to end their program when the VCU department tells us it is complete, thus activating the 24 month bar. However, IF the scholar plans to transfer to another J-1 scholar/ professor program within the next two months, AND IF we get ADEQUATE information from the new program, we can maintain that SEVIS record in “active” status until the transfer date. The information we receive will have direct consequences on the scholar’s future opportunities in the US.
  • 2. We will issue the DS-2019 only when we have the following documentation with all required attachments: 1) NEW: J-1 DS-2019 processing fee $30 due to GEO-IS at time of DS-2019 application. This fee may be transferred via Journal Voucher to index number 1- 10209 (account 600099). Please write the journal voucher number on application form. 2) A letter from the department inviting the scholars and outlining their program objectives for VCU. 3) A statement of financial support from his or her sponsor that must include the proposed dates of the visit, the funding source and confirmation that he or she will be compensated a minimum of $1500 per month. The compensation amount must be appropriately documented in the form of a bank statement, a letter from the sponsor or a letter from a bank official. An adequate amount of funding must be received during the entire proposed length of stay at VCU. 4) If the request is for a scholar or student coming from outside the U.S., a legible copy of the passport pages identifying legal name and date of birth must accompany this request. If the request is for a scholar or student transferring from another institution within the U.S., copies of all prior DS-2019 forms must accompany this request. VCU will issue a DS-2019 on the day of arrival if the current institution approves the transfer. Note: Please read category descriptions on the GEO-IS Web site before determining which category to use for your visitor, as some categories have legal restrictions. 5) A copy of the terminating degree certificate with a certified translation. 6) Complete the last page of the attached form if spouse or children under 18 will accompany the visitor. Additional financial support for the dependents must be included in the statement in item 2 above. A minimum of $5000 per year must be provided for each dependent. 7) If the sponsoring department would like to advance the scholar up to $1,000 for immediate financial support, there are instructions for the Foreign Visitor’s Loan Program on the VCU Web site at http://www.vcu.edu/treasury/FVLP.htm. IMPORTANT: Federal regulations governing the Exchange Visitor Program require that all exchange visitors and dependents have health/accident insurance that includes repatriation costs for remains and medical evacuation coverage during their stay in the US. Under the regulations, the university is not required to pay for the insurance coverage, but must ensure that the visitor and all accompanying dependents have coverage that is valid in the U.S. Also, J-1 exchange visitors are not eligible for a social security number if they will not be receiving any US funds. Please keep this in mind when sponsoring a visitor who will not be receiving US funds. (Please attach documentation to confirm that the visitor was informed of this federal regulation and that he or she should present proof of coverage upon his or her arrival at VCU.) Updated 2010 Global Education Office - Immigration Services 817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552
  • 3. J-1 Scholar Request Please provide the information requested below for the issuance of a DS-2019 form. This form, along with any required attachments, should be submitted to: Global Education Office- Immigration Services, Box 843043, 817 W. Franklin St., Richmond, VA 23284-3043. Please submit the request at least three months prior to the visitor’s expected arrival date to allow time for consular interview. Department Information: Name of faculty sponsor _______________________________________ Campus phone ____________ Alternate contact __________________________________________________ Phone _____________ Department/School __________________________________Campus Box number __________ A photocopy of the letter of invitation to the visitor is attached Yes_____ NEW: $30 Journal Voucher number __________________________ The purpose of this form is to: Visitor’s name: _______________________________________ Begin a new J-1 program Family/ surname First/ given Transfer a J-1 from another program to VCU. If so, the original program begin date on the previous DS-2019 is ___________________________ Month Day Year Activity Information Circle requested category of visitor: (1) Professor (2) Research scholar (3) Short-term scholar (4) Specialist (Note: research scholars and professors can stay up to five years from the begin date on their original DS-2019. Once their program ends they will be subject to the new 24 month bar (not to be confused with the 212e home residency requirement). If the program is going to be 6 months or less, short-term scholar is another option which avoids the 24 month bar.) Proposed length of stay at Virginia Commonwealth University: From: _________________________ To: ____________________________ Month Day Year Month Day Year (Note: please see approximate visa application wait times at http://travel.state.gov/visa/temp/wait/tempvisitors_wait.php) Describe the specific field of study, research, training or professional activity in which the visitor will be engaged (i.e., Visiting professor conducting research in head trauma). ___________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Is the visitor coming to fill a VCU postdoctoral position? YES NO Street address where exchange visitor will perform duties__________________________________ ___________________________________________________________________________________ Updated 2010 Global Education Office - Immigration Services 817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552
  • 4. Funding Information Scholar name __________________________ Indicate below the source(s) of funding* and an estimate of the amount of money (rounded to the nearest dollar) the visitor will receive during the length of the program as will be indicated on the DS-2019 (include in the estimate any perks such as room, board, tuition, etc.): 1. Virginia Commonwealth University (includes positions funded by grants) $__________________ 2. U.S. government agency(ies) _________________________________ $__________________ 3. International organization(s) __________________________________ $__________________ 4. The exchange visitor’s government $__________________ 5. The Binational Commission of the visitor’s country $__________________ 6. All other organizations providing support $__________________ 7. Personal funds $__________________ *Please attach supporting documents that confirm all sources of funding for the visitor’s proposed length of stay. Health Insurance Federal regulations governing the Exchange Visitor Program require that all exchange visitors and their dependents must have health/accident insurance that includes repatriation and medical evacuation coverage during their stay in the United States (not covered by VCU insurance). Under the regulations, the university is not required to pay for the insurance coverage, but must ensure that the visitor and all accompanying dependents have coverage that is valid in the United States. Please indicate who will be responsible for the health insurance payments including medical evacuation & repatriation: _______________sponsoring department ________________exchange visitor Patient Contact Information Is the visitor a physician or dentist? No Yes If no, you can stop here. No additional letters are needed. If yes, will the visitor have any patient contact? No Yes • If no, please complete letter A (see attached sample) • If yes, please note that visitors who are physicians are only permitted to have incidental patient contact as part of their primary educational or research objectives under an Exchange Visitor Program. Please complete letter B (see attached sample) if patient care is expected. The below signers accept responsibility for assuring the payment of any funds obligated by VCU as well as assuring that U.S. government regulations are met on behalf of the visitor(s). They must ensure that upon arrival to the U.S., the visitor meets with a representative of GEO-IS. They also must report to GEO-IS the termination or departure of the exchange visitor from the university. _____________________________________ _________________________________________ Print name of faculty sponsor Print name of dean/department chair _____________________________________ _________________________________________ Signature of faculty sponsor Signature of dean/department chair (Original signatures in blue ink required.) To ensure delivery of the DS-2019 this office will mail the documents to the exchange visitor by Federal Express. If you do not have a Federal Express account, please contact us to make other arrangements. ______________________________ (Federal Express account number) Updated 2010 Global Education Office - Immigration Services 817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552
  • 5. Visitor Information (please print legibly) Male Female Date of birth:__________________ Dr. Mr. Mrs. Ms. Month Day Year ____________________________________________________________________________________ Family/ Surname (As on Passport) Given name (As on Passport) Middle name ____________________________________________________________________________________ City of birth Country of birth ____________________________________________________________________________________ Country of citizenship Country of legal permanent residence Visitor’s level of education _______________________________ Copy of degree attached _____ Visitor’s occupation and place of employment in their country: __________________________________ ____________________________________________________________________________________ Email address: _____________________________________ Address and telephone number where DS-2019 should be mailed:______________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _ (NOTE: If the visitor’s family is accompanying the visitor, please type the following information for each family member on the additional page: family name, first name; middle name; birth date; relationship to scholar; city and country of birth, country of citizenship. A minimum of $5000 per year must be provided for each dependent.) Are or have you (and/or any of your dependents) been in any J exchange visitor status (including J- 2) within the past two years? YES or NO If no, skip to the end. If you ARE in an active J-1 research scholar/ professor program NOW, what is the program begin date on your DS-2019? ____________________ month day year If you (and/or any of your dependents)WERE in an active J exchange visitor status within the past two years, what status? J-1 or J-2 If J-1, what category? ______________________ Attach extra sheet with dependent information (college student, short-term research scholar etc…) Please list the exact beginning and ending dates of your previous periods of J exchange visitor status. Start date __________________ End date __________________ month day year month day year If this application is for a transfer from another institution, have you applied for a waiver of Section 212e? Yes No I pledge that the information above is correct and true. I am aware of the new regulations governing J-1 research scholars and professors and agree to those stipulations. ____________________________________________________________________________________ Visitor’s Family name Given name month day year ____________________________________________________________________________________ Visitor’s Signature Updated 2010 Global Education Office - Immigration Services 817 W. Franklin Street, P.O. Box 843043, Richmond, VA 23284 Tel: (804) 828-0595 Fax: (804) 828-2552
  • 6. Will family members be accompanying exchange visitor? yes no If yes, complete this sheet with the full name, relationship, date and place of birth and country of citizenship for each dependent. Date: _________________ Exchange visitor: __________________________________________________________________ Family name First name Middle name Family Members Accompanying Visitor: Country of legal City & Country Country of permanent Family Name First Name Middle Name Relationship Date of Birth of Birth citizenship residence 1. _______________________________________________________________________________________________________________________________ 2. _______________________________________________________________________________________________________________________________ 3. _______________________________________________________________________________________________________________________________ 4. _______________________________________________________________________________________________________________________________ 5. _______________________________________________________________________________________________________________________________ Eligibility Requirements For J-2 Dependents: Please be advised that dependents are only the spouse and unmarried minor children (under 21 years of age) of the J-1 exchange visitor. Other family members are not eligible for J-2 status.
  • 7. Sample Letter A The following must be printed on departmental letterhead and be signed by faculty sponsor/department chair. The dean of the respective school also should countersign. Please forward the original letter with signatures to Box 843043 or deliver to Room 221 817 W. Franklin St. Please do not hesitate to call if you have any questions. ____________________________________________________________________________ Date To Whom It May Concern: This certifies that the program in which (name of physician/dentist) is to be engaged is solely for the purpose of observation, consultation, teaching or research and that no element of patient care is involved. Approved: ___________________________ Professor and Chair Department of______________ Approved: ___________________________ Dean School of __________________
  • 8. Sample Letter B The following must be printed on departmental letterhead and be signed by faculty sponsor/department chair. The dean of the respective school also should countersign. Please forward the original letter with signatures to Box 843043 or deliver to Room 221 817 W. Franklin St. Please do not hesitate to call if you have any questions. ____________________________________________________________________________ Date To Whom It May Concern: This is to certify that: A. The program in which ______________________________M.D./D.D.S will participate predominantly involves observation, consultation, teaching or research. B. Any incidental patient contact involving the alien physician/dentist will be under direct supervision of a physician/dentist who is a U.S. citizen or resident alien and who is licensed to practice medicine in the commonwealth of Virginia. C. The alien physician/dentist will not be given the final responsibility for the diagnosis and treatment of patients. D. Any activities of the alien physician/dentist will conform fully with the state licensing requirements and regulations for medical and health care professions in the state in which the alien physician/dentist is pursuing the program. E. Any experience gained in this program will not be creditable toward any clinical requirements for medical/dental specialty board certification. Approved: ___________________________ Professor and Chair Department of ______________ Approved: ___________________________ Dean School of __________________